Ekatah Gregory E, Turnbull Arran K, Arthur Laura M, Thomas Jeremy, Dodds Christine, Dixon J Michael
Edinburgh Breast Unit, NHS Lothian, Western General Hospital, Edinburgh, UK.
Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK; Breast Cancer Now Edinburgh Research Team, Western General Hospital, University of Edinburgh, Edinburgh, UK.
Eur J Surg Oncol. 2017 Nov;43(11):2029-2035. doi: 10.1016/j.ejso.2017.08.003. Epub 2017 Sep 4.
Ductal Carcinoma in situ (DCIS) represents 5% of symptomatic and 20-30% of screen detected cancers. Breast conserving surgery (BCS) ± radiotherapy is performed in over 70% of women with DCIS. What constitutes an adequate margin for BCS remains unclear.
A single institution follow up study has been conducted of 466 patients with pure DCIS treated by BCS between 2000 and 2010 of whom 292 received whole breast radiotherapy and 167 did not. Patients were selected for radiotherapy based on perceived risk of in breast tumour recurrence (IBTR). Distance to nearest radial margin was measured; 10 patients had a margin width of <1 mm, 94 had widths of 1-2 mm and 362 had widths of >2 mm. There was no association of margin width and the use of radiotherapy.
At a median follow up of 7.2 years there were 44 IBTR (27 DCIS and 17 invasive). There was no evidence that margin widths >2 mm resulted in a lower rate of IBTR than margin widths of 1-2 mm. The actuarial IBTR rates at 5 and 10 years for margins of 1-2 mm were 9.0% (95% CI ± 5.9%) and 9.0% (95% CI ± 5.9%) respectively and for margins of >2 mm were 8.0% (95% CI ± 3.9%) and 13.0% (95% CI ± 3.9%) respectively. Odds Ratio for IBTR 1-2 mm vs >2 mm was 0.839 (95% CI 0.392-1.827) p = 0.846. In a multivariate analysis only DCIS size predicted for IBTR (HR 2.73 p < 0.0001).
1 mm appears a sufficient margin width for BCS in DCIS irrespective of whether patients receive radiotherapy.
导管原位癌（DCIS）占有症状癌症的5%，在筛查出的癌症中占20 - 30%。超过70%的DCIS女性患者接受了保乳手术（BCS）并辅以放疗。BCS的切缘宽度达到多少才足够尚不清楚。
对一家机构在2000年至2010年间接受BCS治疗的466例纯DCIS患者进行了随访研究，其中292例接受了全乳放疗，167例未接受。根据乳腺肿瘤复发（IBTR）的感知风险选择患者进行放疗。测量了距最近径向切缘的距离；10例患者切缘宽度<1毫米，94例宽度为1 - 2毫米，362例宽度>2毫米。切缘宽度与放疗的使用之间没有关联。
中位随访7.2年时，有44例发生IBTR（27例DCIS和17例浸润性癌）。没有证据表明切缘宽度>2毫米导致的IBTR发生率低于1 - 2毫米。切缘宽度为1 - 2毫米时，5年和10年的精算IBTR发生率分别为9.0%（95%CI±5.9%）和9.0%（95%CI±5.9%），切缘宽度>2毫米时分别为8.0%（95%CI±3.9%）和13.0%（95%CI±3.9%）。IBTR 1 - 2毫米与>2毫米的优势比为0.839（95%CI 0.392 - 1.827），p = 0.846。在多变量分析中，只有DCIS大小可预测IBTR（HR 2.73，p < 0.0001）。
对于DCIS患者的BCS，无论患者是否接受放疗，1毫米的切缘宽度似乎就足够了。
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